Global Fund Replenishment, Making Sustainability Arguments and Simplification Are Keys To Hitting Goal of 2M on Lenacapavir PrEP, says Mitchell Warren of AVAC | IAS 2025

In this second excerpt from an interview conducted before the International AIDS Society meeting in Kigali, Rwanda, Mitchell Warren, executive director of AVAD, a HIV prevention advocacy group, discusses the goal of getting 2 million on lenacapavir preexposure prophylaxis (PrEP) over the next couple of years. In December, before the U.S. election, leaders of the U.S. President's Emergency Plan for AIDS, better known as PEPFARm and the Global Fund to Fight AIDS, Tuberculosis ad Malaria, agreed on a goal of getting 2 million people on "len." PEPFAR is now focused on a much smaller swathe of people, Warren said, but leaders at the Global Fund recommitted to the 2 million goal in June. If that were achieved, it would be the fastest HIV prevention scale-up ever, he noted.

One of the necessary conditions for that to happen is that the Global Fund would need to be replenished. Warren mentioned two others.

The case for spending money on lenacapavir needs to be linked to overall arguments for sustaining HIV and AIDS programs, especially with the Trump administration pulling back PEPFAR funding. "Len is, truly, our best shot at beginning to reduce the number of new infections," Warren said, using the shorthand for lenacapavir. "Part of this is telling governments if you invest in lenacapavir now, you'll be able to sustain your treatment programs because you will have fewer people joining the treatment world."

Warren also said it is essential that PrEP and HIV testing be simplified. They have gotten too complicated and healthcare systems are going to be under stress due to the funding cuts, he said. "We have to be creative," Warren said.

Overall, Warren said, HIV researchers, advocates and communities have always been at the forefront of grappling with the HIV epidemic. "I want to make sure that we don't sit in Kigali and think, 'What could have been,' and give up."